Adecco Medical and Science, a division of the world leader in the recruitment of medical and scientific professionals, has an immediate opening for a Case Management Nurse (RN) on a 2 Month opportunity in San Diego, CA.
Collect case specific member information, review and certify the medical necessity of prospective, concurrent, and retrospective units of inpatient and outpatient services.
Review each case and determine the most appropriate services, the most appropriate setting in which the services should be delivered, the most cost efficient methods for care of delivery, and the need for planning subsequent care for contracted members and their eligible dependents as assigned.
Providing clinical and managed care expertise, as well as Medical Director/physician consultation.
Provide first level clinical review for all inpatient and outpatient services requiring authorization for assigned client group regarding: Prospective Review Urgent/ Non-urgent, Concurrent Review, Retrospective Review, Early initiation of discharge coordination, Analyze case-specific patient information.
Verify eligibility, as applicable, and past utilization history.
Answer telephone calls promptly as scheduled and as needed.
Maintain working knowledge of all client groups Demonstrate adequate competence in computer software use in daily activities.
Document pertinent clinical information regarding individual reviews in SOAP format.
Ensure timely notification of all parties (telephonic and/or written), as necessary, regarding certification recommendations.
Assist in administering the second surgical opinion process.
Handle caller requests addressed to other staff members; acts as a liaison assist the caller by routing to the appropriate person/ staff.
Prepare case files for physician review via Physician Consultant Services or Medical director. This includes preparation of clinical information; correspondence.
Function as a member of a self-directed team to meet specific individual and team performance metrics.
Telephonic discussions with health care providers and members to explain medical necessity determinations and to obtain additional clinical information.
Ensure consistent application of the utilization review process for all functional components.
Document case review findings, actions, and outcomes in accordance with policy. Participate in special projects, as needed Participate in team meetings.
Active CA RN License
1+ year clinical experience in an acute care setting
Previous Case Managment experience
Sound clinical judgment
Demonstrated understanding of managed care concepts
Strong problem solving and decision making skills
Good written and verbal communication skills
Strong time management and prioritization skills
Excellent customer service skills including a sense of urgency and ownership for resolving issues
Knowledge of ICD-9 and CP coding preferred
Considerable knowledge of principles, practices and current trends in nursing
Positive attitude and good work ethics
To be considered for this position, you must use the “apply now” button to submit your resume or email your resume to firstname.lastname@example.org
The Adecco Group is a Fortune Global 500 company and the global leader in HR services. Our group connects over 700,000 associates with our business clients each day through our 6,600 offices in over 70 countries and territories around the world. We offer employment opportunities at any stage in your professional career. Contact us today to discuss available contract and direct hire positions. Adecco Medical and Science offers benefits including Tuition Reimbursement, 401(k), and Insurance Benefit Plans. Adecco Medical and Science is an Equal Opportunity Employer.